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Monthly Archives: October 2012

Government, Insurance and Diabetes….A guide for the overwhelmed

I just learned that the State of California, through it’s Medi-Cal program has created a new policy limiting the number of test strips to be covered by the program. The number is 5x per day for patients using insulin. (http://www.tudiabetes.org/profiles/blogs/medi-cal-is-going-to-change-diabetes-testing-supply-policy )

yeah, that’s right….people on Medi-cal will only be able to test 5 times a day….

This bothers me on so many levels.

1st, I guess Medi-Cal thinks that diabetics prick their fingers for FUN!  And just love when they insert that strip, prick their finger, take the sample and ERROR not enough blood.  Pull the D@#% strip out and start all over again…cause we LOVE wasting strips.

2nd,  any endo can tell you that more testing = better control of blood glucose.  KC wears a cgm and we STILL test at least 7 times a day.  With highs and lows, I might go through 7 strips in one night.

But why should I, a person with good  insurance who pays a co-pay on our strips, care if a state mandates a limit on strips for people on government health plans?

In spring of 2010, I would have shaken my head and said “That’s California for you!”  But then in December of that year, we entered the diabetes world.  A world of vocabulary, laws, mandates, protocols, that I never imagined.  And every month I learn something new.

Here are my top 5:

1.  Medicare creates the codes for insurable goods/services.  If Medicare doesn’t deem them worthy of being paid for at any level by Medicare then they don’t get a code and insurance companies won’t cover them.

2. Insurance companies also follow state mandates/guidelines for what is covered.  So if Medi-Cal determines that 5 strips per day is sufficient then people who live in or work for companies that purchase insurance coverage in California will find that their insurance will only cover 5 strips per day.

3. So to look at this more closely, I will use Blue Cross Blue Shield, which is our insurance.  BCBS does not provide the same insurance coverage for every state.  We live in Tennessee but the company my husband works for is located in Illinois, so we have BCBS of IL.   BCBS of IL and BCBS of TN follow the mandates of their specific states.  BCBS of IL is quicker to approve insulin pumps and cgms than BCBS of TN.

4.  Employers also impact what is covered by co-pays, deductibles etc.  In our case, we were easily approved for both pump/cgm but with a 20% co-pay.  My friends with BCBS of TN had to wait longer for their pumps but had no out of pocket cost.  I don’t know which factor came into play–employer or state mandate.

5.  When a government organization, state or federal, is looking at which medical goods/services/treatments to cover the first consideration is what treatment is the most effective for the lowest cost.

So  ladies and gentlemen of the jury, I ask you this question…what treatment for diabetes is the most affordable?

Syringe and vial.

Not FlexPen.  Not insulin pumps.

Why?  Because people can treat diabetes successfully with the old syringe and vial.  Quality of life, independence and freedom don’t matter.

This is why I fear more government control over healthcare.  Yes, we want everyone who wants to do so to have access to health insurance coverage.  Yes, we need the pre-existing condition exclusion.  Yes, we need extended coverage for our children.  But we don’t need to stop advancements that improve the quality of life for our children.  And I’d bet good money that insulin pumps will not be easier to get with more government intervention.  I hope I don’t have to find out.

If you don’t agree with me….I don’t care.  I’ve heard enough political opinions–this isn’t about politics.   Check out this video on Canadian healthcare  “Why a Mercedes Costs More than A Toyota”

I want my daughter to have access to the BEST healthcare in the world which is what is currently available for the majority of people in this country.  I don’t care if Europe gets new technology approved faster than we do….because most people in Europe won’t have access to that technology anyway.    Check out INPUT to learn more about insulin pump therapy in the UK and nationalized health care.

My advice to anyone with a newly diagnosed T1…educate yourself.  Know what your insurance company requires before you apply for the pump or cgm.  Know the state mandates.  The internet is a powerful tool USE IT!

State Law Mandates  Here is your starting point.  Fight for the best form of treatment for your child with T1.

 

The Cost of Being a Type 1 Diabetic

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